AAP Issues Guidance for New Pneumococcal Vaccine

The recently approved 13-valent pneumococcal conjugate vaccine (Prevnar 13) replaces the 7-valent version in new recommendations for the prevention of Streptococcus pneumoniae from the American Academy of Pediatrics (AAP).

As with the older version, the new vaccine will be adminstered in four doses, at ages 2, 4, 6, and 12 to 15 months, a policy statement from the AAP’s infectious diseases committee, chaired by Joseph Bocchini Jr., MD, of Louisiana State University Health Sciences Center at Shreveport.

The recommendations, published online in Pediatrics, are identical to that issued by the Advisory Committee on Immunization Practices when the 13-valent vaccine was approved in February.

The vaccine is recommended for healthy children up to 59 months of age and for children at high risk of invasive pneumococcal disease up to 71 months old.

Incomplete courses of the 7-valent vaccine should be completed with the 13-valent version, according to the guidance.

Use of the 7-valent vaccine became routine after it was approved in 2000, which resulted in a dramatic reduction in invasive pneumococcal disease. When it was introduced, 80% of cases were attributed to S. pneumoniae serotypes included in the vaccine.

However, the majority of cases of invasive disease currently are caused by serotypes not included in the 7-valent vaccine, highlighting the need for a product with wider coverage.

The newly approved 13-valent vaccine, which includes the seven serotypes in the older vaccine plus another six, should prevent about 63% of cases of invasive pneumococcal disease, according to a report in Morbidity and Mortality Weekly Report in March.

Among the recommendations for its use:

  * For children who completed the four-dose course with the 7-valent version, a single supplemental dose of the 13-valent vaccine is recommended for healthy children 14 to 59 months and high-risk children 14 to 71 months. Children do not need to be actively recalled; they can be given the shot at the next visit.
  * For children who completed the four-dose course with the 7-valent version, a single dose of the 13-valent vaccine may be administered to children ages 6 to 18 who have a high risk of invasive pneumococcal disease because of sickle cell disease, anatomic or functional asplenia, HIV infection or another immunocompromising condition, or presence of a cochlear implant or cerebrospinal fluid leak.
  * Children who are 2 years or older and who are at high risk of invasive pneumococcal disease should also receive the 23-valent pneumococcal polysaccharide vaccine at least eight weeks after their last dose of the 13-valent vaccine. A second dose of the 23-valent vaccine is recommended five years after the first for children with sickle cell disease, anatomic or functional asplenia, HIV infection, or other immunocompromising conditions.

To help with the implementation of the new guidelines and use of the new vaccine, the AAP has issued guidance on supply, payment, coding, and liability issues, which is available here.

The authors did not make any financial disclosures.

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Primary source: Pediatrics
Source reference:
Committee on Infectious Diseases “Policy statement—recommendations for the prevention of Streptococcus pneumoniae infections in infants and children: use of 13-valent pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23)” Pediatrics 2010; DOI: 10.1542/peds.2010-1280.